WASHINGTON - Senior senators reached agreement Thursday on the framework for a bipartisan bill expanding veterans' ability to get health care outside the government's scandal-beset Veterans Affairs hospitals and clinics.

The bill would allow veterans who experience waits of 30 days or more for VA appointments or who live at least 40 miles from a VA hospital or clinic to use private doctors enrolled as providers for Medicare, military TRICARE or other government health care programs.

It also would let the VA immediately fire as many as 450 senior regional executives and hospital administrators for poor performance.

The bill resembles a measure passed last month by the House, but includes a 28-day appeal process omitted by the House legislation.

The Senate deal came as acting VA Secretary Sloan Gibson announced that 18 veterans who were kept off official VA waiting lists in the Phoenix area have died. Gibson said he does not know whether the deaths were related to long waiting times to see a VA doctor.

The 18 veterans who died were among 1,700 veterans identified in a federal report as being kept off an electronic waiting list of scheduled appointments, Gibson said. Taking care of those 1,700 veterans is his top priority as VA chief, Gibson said during a tour of VA facilities in Phoenix, where the furor started.

The Senate bill is a response to a building national uproar over veterans' health care following allegations that surfaced in April that as many as 40 veterans may have died while waiting an average 115 days for appointments at the Phoenix VA hospital or its walk-in clinics.


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Since then, investigators have found long wait times and falsified records covering them up at other VA facilities nationwide. Sen. Sanders comments

"Right now we have a crisis on our hands and it's imperative that we deal with that crisis," said Sen. Bernie Sanders, I-Vt., chairman of the Senate Veterans Affairs Committee.

Sanders and Sen. John McCain, R-Ariz., announced the agreement Thursday following two days of intense negotiations. Both had introduced competing versions earlier in the week.

McCain said the bill was "a way to help to relieve this terrible tragedy that has befallen our nation's veterans."

"While this is not the bill that I would have written, we have taken a significant step forward with this agreement," said Sanders.

Sen. Patrick Leahy, D-Vt., commented in a press release, "I commend Senator Sanders and Senator McCain for putting veterans' needs above all the partisan finger pointing. We need to put things right in the VA health system, we need to do it promptly, and that can only happen if we work together."

The bill also authorizes the VA to lease 26 new health facilities in 18 states and spend $500 million to hire more doctors and nurses. The VA now has 150 hospitals and 820 clinics nationwide. Senate leaders said they hoped to bring the legislation to the floor soon but offered no specifics.

The measure calls for independent commissions to look at how the VA can do a better job in terms of scheduling appointments as well as a commission on VA construction.

Among other veterans issues which have enjoyed widespread, bipartisan support in Congress, the bill would make certain that all recently-separate veterans taking advantage of the Post 9/11 GI Bill get in-state tuition at public colleges and universities. It also, for the first time, would extend Post 9/11 GI Bill education benefits to surviving spouses of veterans who have died in the line of duty.

Congressman Peter Welch, D-Vt., applauded the work by Sanders and McCain. "The cost of any war must include the cost of caring for warriors when they return home. That solemn commitment has been shaken by recent events," Welch said in a press release. "It is essential that we get to the bottom of what caused these problems and eliminate bureaucratic roadblocks to timely and high quality health care for veterans. Congress should act quickly on reforms to restore the confidence of veterans and their families in their health care system."

Nomination withdrawn

Meanwhile, President Barack Obama's choice to be the top health official at the Veterans Affairs Department withdrew his nomination Thursday, saying he feared his confirmation could spark a prolonged political battle.

Jeffrey Murawsky, health care chief for the VA's Chicago-based regional office, was nominated last month to be the department's new undersecretary for health care, replacing Robert Petzel, who resigned under pressure. Petzel had been scheduled to retire later this year but was asked to leave early amid a firestorm over delays in patient care and preventable deaths at veterans hospitals.

Murawsky now oversees seven VA hospitals and 30 clinics in Illinois, Indiana, Wisconsin and Michigan, including one in suburban Chicago where there are allegations that its staff used secret lists to conceal long patient wait times for appointments. Murawsky was a doctor at the Hines, Illinois, hospital and remains on its staff. In a statement provided to The Associated Press, Murawsky said his withdrawal was "in consideration of recent events, but most importantly in the best interests of serving our nations' veterans."

The White House said in a statement that Murawsky feared a prolonged fight over his confirmation, adding that he believed the role was too important not to be filled quickly.

Obama accepted Murawsky's withdrawal and will move quickly to find a replacement, the White House statement said. The VA is required by law to convene a commission to seek and review candidates for the position, which oversees the Veterans Health Administration, the largest single health provider in the nation with 9 million patients, 150 hospitals and 820 walk-in clinics.

Robert Jesse, Petzel's chief deputy, has served as acting undersecretary since Petzel resigned May 16

Gibson took over the VA temporarily last Friday after former Secretary Eric Shinseki, an ex-Army general, resigned under pressure. Gibson promised a number of changes to improve patient care, including greater use of non-VA doctors, especially in rural areas. He also said the agency has done away with a controversial 14-day waiting period for first appointments. Critics said the goal was unrealistic and created an incentive for schedulers and other VA employees to falsify records to earn bonuses and other rewards for meeting performance goals.

Associated Press writers Terry Tang in Phoenix and Donna Cassata in Washington contributed to this report. Banner County News Editor Mark E. Rondeau contributed to this report.